PERI and POST Menopause Testing and Remedy Choices with Dr. Jill Carnahan

Betty Rocker (00:18):

What’s up, rock stars Coach Betty Rocker right here. Hey, thanks a lot for becoming a member of me. My visitor at the moment is Dr. Jill Carnahan, a frequent visitor on this present. You might have heard her earlier than. She is dually board licensed in household medication, a practitioner of built-in holistic medication, and can be a purposeful medication skilled. She’s the writer of Sudden, a really inspiring learn, and he or she’s additionally the topic of a documentary known as Physician Affected person. She’s obtained a wonderful podcast and a extremely, actually useful weblog, simply full of nice free content material you possibly can entry anytime and is a survivor of breast most cancers, Crohn’s illness and poisonous mould sickness. She brings a novel perspective to treating sufferers within the midst of complicated and persistent sickness. She’s the medical director on the Flatiron Useful Drugs Middle simply outdoors of Boulder, Colorado. And my very own private physician and I at all times really feel actually fortunate to get to work along with her and likewise to have the ability to share her with you guys as a result of she actually helps make sense out of so many complicated well being associated topics which might be related to us all. Please be part of me in welcoming her to the present. Nice to see you, Dr. Jill. Thanks a lot for becoming a member of me at the moment.

Dr. Jill Carnahan (01:31):

You’re welcome. So good to be with you once more.

Betty Rocker (01:34):

Sure, it’s at all times nice to get to test in and, and have a dialog. And one factor I really feel like has been on my thoughts and on the minds of most of the girls I serve, um, is that this dialog about menopause, perimenopause and publish menopause. Proper? The all-encompassing menopause umbrella, . And it’s nice to see menopause having its day. I really feel like lastly we’re listening to extra about it. There’s much more analysis than there was. And after I assume again to our conversations perhaps early on in my very own perimenopause journey, I take into consideration how a lot nervousness I had about listening to about issues like bioidentical hormones or hormone alternative remedy and the way that dialog type of advanced and the way rather more we all know today. Why, why are folks nonetheless, I really feel like there’s nonetheless lots of worry round hormone alternative remedy, although. I imply, simply to get us into it, like the place’s that come from?

Dr. Jill Carnahan (02:33):

Properly, it really comes from our occupation and I’ll let you know the story and it’ll make a lot sense. So I graduated 2001 and obtained out of medical faculty and that yr was the yr the Ladies’s well being Initiative first got here out within the information. Because the researchers are compiling the info, the information took this info earlier than they even completed compiling and stated, oh my goodness, is there an elevated threat of breast most cancers with hormone alternative? And actually a whole bunch of hundreds of ladies stopped their hormone alternative as a result of this media took this story, put it on the market. And at the same time as a physician, that was the story that we had been informed. So all of us began, that is 20 plus years in the past, being afraid of this. What occurred in that 20 yr sense is that they analyzed the info in that largest randomized management trial of ladies on hormone alternative. And the info got here out very clearly.

(03:18)
Primary, there was two arms, one was an estrogen solely arm, they usually used Premarin, which is definitely a horse estrogen, not even the very best cleanest bioidentical, however it’s an estrogen. And the opposite arm was a Premarin, which is an estrogen plus, um, a purvey, which is an artificial progestin. I’ll clarify that actual briefly in a minute. So these two arms, the primary arm got here out and this has been the final, uh, analyzed analysis, properly documented by anybody who’s checked out this. There was really a 34% discount in breast most cancers in that arm. So not solely was it not impartial like simply, or or dangerous, it was really a discount. And we’ve recognized for all of this time that hormones, particularly estradiol, helps the mind, the bone, and the um, menopause signs dramatically and the guts. So these issues had been by no means questioned. It was solely this query about breast most cancers.

(04:09)
Now, in that different arm, right here’s the place the controversy got here in. They’d this slight improve above baseline with the Premarin Provera arm for breast most cancers incidents. However what occurred is what they had been, um, going towards because the baseline really had the next incidence of regular. So it skewed the info. And the second factor about that was, as I discussed earlier than, this was an artificial progesterone. It wasn’t progesterone in any respect, which might really mimic progesterone deficiency in the long run as a result of it hits these receptors, however it’s not a pure progesterone. So neither of those trials, despite the fact that they confirmed a decreased threat of breast most cancers, had been even utilizing the type of hormones that you just and I are speaking about, which is the very same as our our bodies, our ovaries produce. So I confidently, and also you talked about earlier than, I’m a breast most cancers survivor, so I’m 20 plus years out.

(04:53)
And for me, it is a very private situation. ’trigger right here I’m in menopause and I’m like, what’s protected for me? As a result of I’ve had breast most cancers and I can confidently say with no shadow of the doubt, I used to assume we had to decide on. We don’t. I believe so long as you may have a superb practitioner who is aware of what they’re doing, you’re checking ranges. And we’ll discuss all that at the moment. Um, it is a big situation for girls and it’s gonna have an effect on bone, mind and coronary heart in a superb constructive manner. And now we expect it could even be protecting towards breast most cancers.

Betty Rocker (05:25):

I’ve been studying that knowledge as properly and it’s nice to listen to it from you. And a part of why I needed to ask you that query to start out us off is in order that you realize that you’d share that you’re a breast most cancers survivor. It’s one thing that’s so deeply private to you. I do know that there’s no manner that you’d’ve prescribed that to me. You wouldn’t have prescribed hormone alternative remedy to me or to quite a few different sufferers you’ve served in case you thought there was a threat for us. Now, in fact, there are gonna be some individuals who it’s contraindicated for. There’s sure issues as a clinician, I’m certain that you just have a look at, I’m certain there’s the blood clotting issue. There’s all of those various things that we wanna be careful for, and that’s one thing that when somebody’s individually working with a physician, they should care about.

(06:06)
However I believe it’s actually essential to simply, despite the fact that that was, to me that was just a little technical, what you shared, and in case you’re listening and also you’re pondering, I didn’t fairly comply with the whole lot she was saying, however it, you perceive the info as mm-hmm . A health care provider who reads the science, you perceive that it’s protected. Sure. That’s principally what you’re saying. And like that these research in some methods had some actual flaws. Sure. They had been finding out, um, types of hormones that we don’t really use in girls’s medication. And in addition that the, the, and, and so it, and so there’s all this worry, there’s all this worry round it. And, and it’s not for everybody both, proper? Like, you’re proper. I do know we’re not gonna say, oh, everybody must be on hormone alternative remedy, however

Dr. Jill Carnahan (06:46):

In the event you’re present process breast most cancers therapy, for instance, I might not give somebody hormones throughout therapy. In order that’s a really clear contra.

Betty Rocker (06:52):

Proper. So there you go. There’s a, there’s a motive not that, and there are most likely another causes too. And, and but it must be an accessible, viable choice that ladies have entry to is all I’m seeing with out all of the worry. And, and that’s why I needed to simply begin us off speaking about that. ’trigger you realize, if we’re gonna get into a few of the viable therapy choices for girls within the menopause years, it’s essential to know that we’ve thought of this initially, as a result of I believe security, girls’s security and, and and their entry to healthcare choices is actually essential. It’s important. Yeah. At all ages, and that is an age that I really feel like has been neglected, has been ignored, has been too lengthy, simply type of like, you’re simply getting previous. I can’t let you know what number of girls have written me, and also you’ve most likely seen this in your follow as properly, saying, I’ve been dismissed, I’ve been informed I used to be depressed. I’ve been placed on anti-anxiety medication. I’ve been informed I want to simply train extra and eat much less. I’ve been informed I’m simply lazy. Um, it’s all in my head. I’ve been placed on contraception, like all of those various things which might be like getting at signs however probably not addressing the basis trigger, which is that this shift in our hormones that occurs. I don’t know, it’s simply, it’s it’s

Dr. Jill Carnahan (08:05):

So true. And I really like that you just stated it’s even at the moment, day by day in my follow, I’ve these discussions with girls and there’s some who select to not, and that’s okay too. However everybody deserves a dialogue with an informed supplier. Um, and in case your supplier is completely no, and there’s no dialogue, you then wanna discover a totally different supplier as a result of it isn’t for everybody. And there’s a vital selection. And you probably have lots of nervousness or worry, I by no means push anybody. So there’s nonetheless, I could also be perhaps 20% of my girls that we discuss they usually don’t go on hormone alternative, and that’s okay too. However to have the choice and to know the

Betty Rocker (08:34):

Selection, you stated selection. That’s the phrase. That’s, that’s it. And the training about it, to know which you could make an knowledgeable selection for your self to know there are threat elements for sure folks, after which a few of us there aren’t. Properly, let’s discuss just a little bit in regards to the, the phases of a lady’s life that we undergo. There’s the perimenopause years, these years main as much as menopause, the occasion the place our interval stops for 12 months after which we’re within the postmenopausal years. So there’s actually perimenopause and publish menopause and menopause type of like defines that cusp the place we go to the following stage, as we name it. Proper? And, and so there are girls who come to you at, at these totally different phases of their menopause journey. They usually wanna know all types of issues. Like, properly, how do I do know I’m in perimenopause? How do I do know I’m, how do I, what, what ought to my hormones appear like at these totally different phases? And I might think about that these are the type of issues that you just assist deal with in your follow. So if, if somebody involves you and says, I believe I’m in perimenopause, or I’m having these bizarre signs, what do you take a look at for? And how much signs do they present up with? In order that perhaps you would, we may assist somebody on the market who’s attempting, who’s perhaps struggling proper now or attempting to determine what to ask their

Dr. Jill Carnahan (09:44):

Physician. So generally girls as younger as 35 can begin to expertise these perimenopausal signs. And normally from 35 to 45 is that realm. It will possibly go so long as 55. I believe the typical age of that menopause date is round 52, 55. After which after is publish. However this may once more be virtually a 20 yr span from 35 to 55 that some girls wrestle. So one factor I’m a fan of, and never all medical doctors do that is testing. I take advantage of blood, urine, several types of issues to evaluate various things. And it is a entire nother lecture value of fabric as a result of relying on in case you’re utilizing a cream or an oral or the way you’re doing it, sure assessments choose up issues in another way. And that’s a complete different dialogue. But it surely’s essential that you’ve got a physician that may assess the place you’re at as a result of you may have the signs sometimes.

(10:26)
And the signs can, um, for instance, in that early half, so say 35 to 45 or 50, typically you begin to first have a scarcity of luteal section progesterone. That’s normally the very first thing that drops. So that you typically expertise estrogen dominance and hormones are all about steadiness inside each other. So if we have now our cycle follicular section, estrogen goes up, second a part of our cycle, luteal section, progesterone goes up and that simply yin and yang occurs all by means of our twenties and thirties. Properly, in our late thirties or early forties, what begins to occur is that progesterone will typically diminish manufacturing. So you may have this dominance of the estrogen all through the cycle that may trigger breast tenderness, moodiness, heavy, painful intervals, uh, endometrial ache, endometriosis, fibroids, all these sorts of issues. And that may be a symptom in and of itself that may be handled with pure progesterone or generally herbs that may improve the lead section progesterone.

(11:16)
And that’s normally the very first thing. Then someplace in there your ovaries begin to sputter. And I at all times say it’s virtually like in case you had a bottle of Heinz ketchup and also you’re squeezing out the final bit and the, then the hormones are beginning to go, you realize, simply kinda like this little simply really fizzling out. There’s a large number of a spurting out and someone can have a day that’s excessive and high and low and you’ll’t determine what’s happening. And even testing, you need to watch out as a result of in case you’re testing that interval, you take a look at one month, you might need excessive estrogen, low progesterone the following month it is likely to be low and it simply does this dance. And that’s the time when girls are so pissed off ’trigger like, I don’t really feel properly what’s happening? They could begin to have scorching flashes, however they’re nonetheless having heavy cycles.

(11:50)
And so in that window, girls can nonetheless do bioidentical hormones. But it surely’s essential to have a clinician that is aware of how one can assess the signs associated to what they’re possible experiencing hormonally. After which additionally take a look at realizing that the take a look at will be up and down. And in that section it’s gonna be just like the Heinz ketchup spurting out randomly. And you then get to some extent the place these ovaries similar to, I’m accomplished. And that’s when the estrogen begins to essentially drop. And that is when girls would begin to have scorching flashes, evening sweats, unexpectedly they can’t bear in mind names. Locations the place they put their keys, the place they’re going, they get within the automotive like the place am I driving to? Like issues the place they actually, girls have come to me and stated, I believe I’m dropping my thoughts. They will begin to have this such as you and I’ve been pushed girls in our subject.

(12:33)
And I do know after I first hit menopausal, just like the overwhelm, the sensation like I couldn’t deal with issues usually is actually frequent with girls. ’trigger they’re pushed they usually’re doing properly and the estrogen actually helps our mind keep on observe. And when that drops we’re like, oh wait, my government perform, the planning, the executing is impaired. And I’m like, I really feel like I’m dropping my thoughts. Or that the issues that I used to have the ability to deal with are more durable. Mm-hmm . Emotionally, you’re up and down. It’s possible you’ll be extra tearful in the future extra indignant, in the future extra unhappy, you received, don’t wanna get outta mattress in the future and when none of these issues had been there earlier than. So I really like speaking to girls as a result of so many ladies actually really feel like they’re going loopy if nobody validates this and it’s a standard expertise, however it could actually really feel so disorienting. And you realize, even the dad so far as damaged relationships and divorces on this time, it’s not shocking that that goes up as a result of girls really feel like they’re going loopy. And most males and plenty of medical doctors gaslight them into pondering they’re going loopy and it’s simply their hormonal transition.

Betty Rocker (13:29):

So I hear you saying that there are these actual distinct phases of perimenopause that we undergo and because of this it’s more durable to pinpoint generally as a result of it’s a transferring goal. Sure. As we undergo these, these years of our lives. And it’s shocking to listen to you say that it could actually begin as early as 35, however it additionally is smart, proper? And, and it, I assume it’s possible you’ll not know precisely the place you’re. It could not go precisely together with your age. Proper? So if we keep on the perimenopause dialog for a minute, say

(13:57)
Say I’m a youthful girl, or say I’m like 40 years previous mm-hmm . And I come to you and I say, I believe I’m in perimenopause. What would you particularly take a look at for? I can bear in mind a few of the belongings you examined me for particularly after I got here to see you. And naturally I had complicated signs and many various issues happening. It wasn’t simply menopause after we first began working collectively. However I do keep in mind that over time you’ve examined me for some particular staple items. Sure. To assist see what if, if it was perimenopause. So would you share a few these? Sure.

Dr. Jill Carnahan (14:31):

So one factor is this may be accomplished at any standard lab. And despite the fact that blood work isn’t at all times good, in case you’re utilizing like a cream or no matter, it’s a terrific place to start out. It typically will likely be coated by insurance coverage. And what you’d wanna do is a fundamental panel. Estradiol is the principle E two estrogen and you will get estriol and estro. However simply estradiol is an effective place to start out.

Betty Rocker (14:48):

Simply to say simply she stated E two after which she stated all these issues. In order that’s E one, E two, and E three. There’s three varieties of estrogen. So estradiol is E two and that’s the one you wanna learn about, proper?

Dr. Jill Carnahan (14:58):

Yeah, that’s the principle one. So once more, it’s nice if you will get ’em all, however in case you simply get one, get estradiol. And currently the lab now has a extremely delicate estradiol. So HS are extremely delicate is best as a result of that is very, very, very tiny components within the blood. So that they’re measuring little tiny issues and it will get just a little extra, um, particular and delicate with that extremely delicate estradiol. You wanna get proactive.

Betty Rocker (15:17):

Do you need to get a particular take a look at to check for that. Does your physician,

Dr. Jill Carnahan (15:20):

No, this could possibly be only a common LabCorp quest common hospital lab. Simply writing estradiol on the lab order would do it.

Betty Rocker (15:27):

Okay, good. Good to know. Okay. Sorry to interrupt. I simply needed to ensure there wasn’t one thing particular we needed to ask for .

Dr. Jill Carnahan (15:32):

Yeah, no, estradiol. After which progesterone additionally vital. ’trigger we at all times have a look at the ratio. Similar to we stated, these two are the dance companions. So we’re checking these two in conjunction. Um, if I’ve a selection, I’m testing all these and I’ll proceed with the remainder of them on day 19 by means of 21 of the cycle. In order that’s assuming you may have a typical 26, 28 day cycle ’trigger that’s gonna hit your LAL section. And what you’re gonna see there may be if the estrogen and progesterone are in steadiness. Proper? In order that’s the timing of what you would possibly do for this. So estradiol, progesterone, DHEA sprint S is how we take a look at DHEA, which is one other steroid hormone within the blood. Testosterone, I wish to get each free and complete. Mm-hmm . After which cortisol within the morning. ’trigger that’s type of an ordinary, though you would get it randomly by means of the day. And in case you simply get these 5 estradiol progesterone, uh, DHEA free and complete testosterone and cortisol, you’re gonna have a reasonably good thought. Now you will get fancy and get one thing like DHT. This can be a, a really potent steroid hormone like testosterone that may trigger hair loss or may cause zits or PCOS. However you don’t must get that fancy. In the event you simply get these imply 5, that’ll provide you with a superb map.

Betty Rocker (16:38):

And I bear in mind these. That’s that fundamental panel I’ve had repeatedly and I needed to the touch on that as a result of A, these, so that you’ve had these assessments accomplished for me a number of methods over time. So to start with we might do a mixture of the Dutch take a look at, which is a urine take a look at that we do on these very particular days of the luteal section of the cycle. And you should be monitoring your cycle with a view to know the place you’re and when your luteal section is. And I discover that it’s really actually useful to be monitoring your cycle if you’re in perimenopause as a result of it’s gonna provide you with some indication of realizing as your cycle begins to get erratic. It, it’s straightforward to simply neglect about your cycle. Actually, I typically would neglect I used to be even gonna get my interval in my common biking years as a result of it was simply so like I I might be like, oh, this once more.

(17:27)
Proper, proper. Yeah. I wouldn’t have a lot sense. Me too. Proper. So, however now, like in perimenopause it’s been actually useful to trace it, to have a way of it. And I, in fact I’m sporting my Oura ring and that basically helps me. ’trigger I can see my basal physique temperature go up when round ovulation and it stays elevated by means of that second half of the cycle. However anyway, again to, um, these assessments, I might sometimes try this Dutch take a look at. You’ll order that Dutch take a look at for me, the urine take a look at. After which I might additionally go fasted very first thing within the morning, early morning and get a blood take a look at as properly. And that was the place you had been checking that T three, the free T three, the, the free thyroid hormones. Proper. The free T three and T 4. Considered one of ’em is free, I don’t bear in mind. Mm-hmm.

(18:05)
However T three and T 4. And you then, you’d even be checking the fasting cortisol within the morning ’trigger we’d wanna see like the place that was. After which we’d additionally additionally, I believe you would see issues like testosterone and you would see the opposite hormones mm-hmm . Um, however it was the, the mixture of that with the Dutch take a look at that collectively gave you a a lot clearer image of what you needed to see that may show you how to see if my hormones had been in steadiness, how out of steadiness they had been. We began to see over the course of the few years that we examined these two issues again to again the, the blood and the urine, how my hormone ranges actually went down and down and down. Yeah. And I bear in mind to start with I used to be in a position to get by with merely utilizing some adaptogenic herbs that basically helped help my stress response and helped nourish my hormones.

(18:52)
And, and I used to be in a position to really feel higher despite the fact that it didn’t actually make my hormone ranges go up a lot, I felt quite a bit higher and it lowered lots of the signs I skilled. However then as I obtained just a little farther into the perimenopause journey, it turned actually important for me to start out utilizing issues like hormone alternative remedy. After which I really feel like I’m perhaps within the, the tip of that center stage of perimenopause now I’m like utilizing a mixture of several types of hormone alternative remedy. I’ve some props right here to indicate you guys, in case you’re watching this on YouTube. I’ve obtained my patch mm-hmm . So I take advantage of this little patch and I’ll simply open up the little foil packet so you possibly can see it. It’s just a bit sticker that I placed on and, um, you modify it each few days. Or Dr.

(19:40)
Jill had even given me some suggestions as I’m very delicate to lots of these things the place we tried it for an extended interval at the beginning to see how I responded. After which we examined once more a couple of months later and I’ve additionally obtained some totally different lotions, topical lotions. She prior to now had had me attempt, an oral progesterone. And we discovered that for me personally, the standard advice was I believe to take it at evening. My physique didn’t like that, so I took it within the morning. So there’s simply all of those nice tuning type of nuanced points of this. After which there’s additionally a pellet, which I do know you really helpful for very particular conditions, however in case you’ve obtained a pellet injected below your pores and skin, which we talked about in different podcasts, you possibly can’t change that. Yeah. It’s there. You may’t take it out simply your self. Proper. So it simply gotta do its factor so it’s much less customizable. Whereas with the lotions you want, you are able to do two clicks, you are able to do one click on, you possibly can actually management your dosing, I believe actually, rather well. These are all issues that I’ve skilled based mostly on the testing. And I may also say that you just and I examined a superb quantity, like it could be a, a couple of occasions a yr we might take a look at to see like

Dr. Jill Carnahan (20:51):

Each three to 4 months. That’s

Betty Rocker (20:53):

Nice. Each Yeah. Completely. To see like, how did my physique reply to the therapy? We needed to provide it sufficient time for it to, to have some impact. And we needed to then see how was the physique doing with this stuff. After which if there was, if one thing responded, we may see that. And if it didn’t, we may alter my dosage. However we didn’t simply go actually quick into issues we needed to like take. And that may be, that may be just a little little bit of a course of, proper? Like, ’trigger you need outcomes instantly, however in case you overdo it, you possibly can really feel worse. And that’s,

Dr. Jill Carnahan (21:26):

That’s like, you don’t need breast tenderness with the estrogen, which is the use typical. And one factor, lots of people are fearful about clot threat. And what if I’ve this, uh, there’s totally different gene issues that you just would possibly’ve been informed

Betty Rocker (21:35):

Issue V(5) Leiden, proper? Like that’s my household. Yep,

Dr. Jill Carnahan (21:38):

Yep. Or, um, sure different ones on the market. And so in case you’ve been informed that’s a threat, the deal is oral hormones, particularly estrogens do improve the chance of clot. It’s why you’ll virtually by no means see me prescribe oral estrogen as a result of I don’t wanna even go in that class, proper? Mm-hmm . Transdermals don’t have the identical threat. Transdermal simply means a patch or a cream or one thing you apply to your pores and skin. Our pores and skin absorbs hormones rather well mm-hmm . So I virtually completely do the compound of lotions that you just confirmed or the patch that you just confirmed. And, um, there’s other ways to do these, however these are actually nice and protected methods to use. Now you talked about typically doing blood and urine on the similar time. The dutch hormones is what you talked about. I sometimes to comply with the hormones, love to do the Dutch, as a result of within the blood you received’t at all times see the true ranges of a cream or a patch.

Betty Rocker (22:25):

Mm-hmm .

Dr. Jill Carnahan (22:25):

So I generally do each, like we did with you. If I’ve a affected person who’s prepared to do each, that’s the very best. However you possibly can see the variations as a result of in case you’re actually following a cream or a patch or a protocol, um, your Dutch urine take a look at is gonna present extra the correct ranges of your physique versus the blood.

Betty Rocker (22:41):

Mm. That’s tremendous fascinating. So if somebody had been simply attempting to comply with their hormones, in the event that they had been simply, if they might simply take a look at type of consecutively, perhaps not each month clearly, however like on an honest foundation, perhaps each three or 4 months they might use the Dutch take a look at as their main to, to see in the event that they had been doing hormone alternative remedy. Sure. Now you talked about compounded.

Dr. Jill Carnahan (23:04):

Sure.

Betty Rocker (23:04):

That that’s, so, so there’s a few several types of these transdermal or cream-based mm-hmm

Dr. Jill Carnahan (23:10):

.

Betty Rocker (23:10):

Hormone alternative remedy varieties. Might you wanna communicate on that just a little bit? I really feel like there’s lots of

Dr. Jill Carnahan (23:15):

Certain.

Betty Rocker (23:15):

There’s, you hear about HRT, you hear about BHRT. Yeah. You hear about all these things. So inform us in regards to the variations

Dr. Jill Carnahan (23:21):

There. Certain. And simply to reiterate what you stated about testing my customary affected person, we would begin them on a protocol and normally about each six months is type of when, generally sooner in the event that they’re having signs, however on a routine, and on the very least, I’m gonna test them yearly.

Betty Rocker (23:35):

Certain.

Dr. Jill Carnahan (23:35):

So all people who will get hormones is required by me to do a yearly take a look at. So I do know, and generally extra ceaselessly if we’re altering doses, in the event that they’re actually steady, yearly does fairly good. Certain. Like I’m at a spot now, I do every year and I’m steady on doses. So what is accessible? So there are common pharmaceutical professional prescriptions you will get at CVS, Walgreens or your common pharmacy which might be bioidentical hormones. Estradiol, as we already talked about, is the principle hormone that you just’re gonna see. And this may be prescribed as a cream, um, as a, um, foam like a, roll-on, as a patch, which is my favourite most typical ’trigger girls don’t have to consider it.

Betty Rocker (24:09):

Yeah.

Dr. Jill Carnahan (24:09):

Um, so there’s plenty of other ways. And that is just one, it’s the E two, the estradiol that’s essentially the most sturdy. It really works, it’s a good way to do it. However lots of occasions girls wish to have a mixture and we are able to prescribe compounded estriol, which is that weaker type of estrogen. And for instance, if we have now somebody who has current breast most cancers or very, very involved, estriol is type of a caboose, estrogen which means finish of the road. And the physique doesn’t take and make different issues with it. So it tends to be the most secure, even amongst oncologist with somebody being handled for breast most cancers with vaginal dryness, they might say, oh, one of these estrogen is actually protected. So you probably have any concern, you possibly can at all times compound these. And infrequently I’ll do both 80 20, imply 80%, one 20% one other or 50 50, and also you mix these two estriol and estradiol right into a cream. And since you possibly can compound it, I can begin with a lot tinier doses for somebody who’s actually delicate. And you may also put progesterone in that cream. So lots of my girls have like a biased which means like two varieties of estrogen with just a little progesterone multi function, they usually use a pair clicks on their pores and skin at bedtime or morning. So it may be fairly straightforward to do, however that manner I can really choose the precise dosages for that particular person affected person and alter it based mostly on their outcomes with nice tuning.

Betty Rocker (25:24):

That’s so cool. Uh, I really like that. I, I really feel like I’ve been having my very own little apothecary over right here. Yeah. And I can see that my estriol estradiol is a combo and I can, I’ve a separate progesterone mm-hmm . And I even have my little testosterone.

Dr. Jill Carnahan (25:42):

Sure.

Betty Rocker (25:42):

And that’s been I really feel like actually useful. Um, sure. You wanna discuss just a little bit about that as a result of we don’t typically discuss testosterone and, and

Dr. Jill Carnahan (25:50):

I do as a result of I get so enthusiastic about, simply, so that is, we consider it as a male hormone. We now have testosterone – decrease than males, however we have now testosterone. We want testosterone. It helps our bones, it helps our brains, it helps our motivation, it helps our physique composition. Ladies who’re poor in testosterone. It’s one of many the reason why there may be 4 occasions the incidence of autoimmunity in girls as there may be in males, as a result of that decrease testosterone really will increase threat of autoimmunity. So there may be, I’ve even used off-label testosterone as a part of a protocol to deal with autoimmunity as a result of it’s so highly effective in girls. So I’m an enormous fan now. You don’t need extreme, however getting the fitting dose will actually change your life, your thoughts and all these issues. Along with the estradiol libido for girls, it completely has an impact. Vaginal dryness.

(26:39)
And like I stated, bone and mind are big with testosterone. So testosterone will be given as a, we virtually by no means wish to give a capsule the place you swallow as a result of your liver has to course of estrogen, testosterone, no matter. And we don’t wanna load up the liver. So I’m at all times attempting to bypass the intestine with hormones that’s both a cream or a patch. With testosterone, there’s a pair methods you are able to do it. You are able to do a cream, however for girls, wherever you apply that cream, interior thigh or wrist, you’re gonna get just a little hair progress. So lots of girls don’t like that. And so as an alternative of doing the cream, I’ll typically do a trochexf or a sublingual tab that dissolves below your tongue so that you just get that dose with out moving into your intestine and thru the liver. Um, lots of girls, uh, do injectable now.

(27:19)
It was that the industrial types had been just for males. So to get the tiny doses that we wanted, had been actually arduous to attract it in a syringe. However I do discover, properly now we are able to compound it like girls concentrations. And I do like, so long as girls’s are afraid of doing a injection as soon as per week or as soon as each 10 days, that’s a good way. It sometimes does give a stage that type of goes up and down each time you inject. So you may have just a little bit extra variation than you’ll with a each day dose. So testosterone will be cream, it may be in troche or an oral sublingual, and it may be injectable. And people are the principle methods. And since proper now our pharmaceutical trade is geared in direction of males and testosterone, many of the industrial, if not all the industrial, um, ones, patches, lotions, even injectable, are sometimes made for male dosing. So that is sometimes compounded for girls, um, to get that dose.

Betty Rocker (28:06):

And also you and I’ve discovered that my physique simply loves that. It simply, it simply has actually helped me a ton. Mm-hmm. And I’ve taken such a tiny dose over the, the time that I’ve been utilizing it. It’s been actually useful, I really feel like, for steadiness. After which I additionally take, um, the oral DHEA complement to assist, as a result of that’s in fact a precursor to is estrogen and testosterone. Proper. It’s a precursor. It helps our adrenal manufacturing. Um, as, and that’s one thing that I at all times so discovered actually fascinating is that due to course we’re making our estrogen and progesterone primarily in our ovaries, however we additionally make some hormones in our adrenals. Appropriate?

Dr. Jill Carnahan (28:46):

Yeah. Sure.

Betty Rocker (28:46):

And if our adrenals get overwhelmed by stress, the stress response, it’s gonna be more durable for them to make a few of these backup hormones. And I bear in mind a extremely fascinating dialog. You and I had some time again the place you had been like, you realize, you see girls who’ve a extremely strong, um, adrenal perform have a better time in, in going by means of perimenopause as a result of they aren’t strapped of the backup hormone system. Nearly. Did I say that proper? That’s

Dr. Jill Carnahan (29:13):

That’s precisely proper. As a result of when our ovaries conk out they usually’re like, I’m accomplished, I’m for drained. Proper. Which is what occurs after we hit menopause. They ovaries cease producing the hormones, our adrenals take over. So we nonetheless do produce just a little little bit of hormones from the adrenal glands after menopause, not almost as a lot as ovarian. But when these adrenals are so taxed, ’trigger you’ve been working 80 hour weeks and never getting sleep and caring for your dad and mom and your youngsters and all these generations, then it’s actually frequent to have a way more troublesome in menopause. And I really like DHEA, to begin with, it’s the one certainly one of these that isn’t requiring a prescription. The remainder of these, you do want a prescription. Proper. Um, and only for the report, testosterone continues to be thought of managed, whether or not it’s athletes or there’s some issues that they, so that’s a kind of which you could nonetheless get a prescription no downside.

(29:57)
But it surely’s within the class of managed prescription. So that you might need to get a decrease quantity, like six months versus a yr or sure issues. Um, however DHEA is accessible over-the-counter and ladies typically do properly on 5 or 10 milligrams upwards of 25. However that’s a reasonably excessive dose for lots of ladies. And what can occur there may be that may help your manufacturing of cortisol. If the adrenals are low and also you’re low cortisol, it’ll help testosterone and DHEA. So it’s type of a pleasant adrenal help in case your adrenals are in a weakened spot. In the event you’re actually excessive cortisol and also you’re liable to breakouts, these are the type of folks I most likely wouldn’t placed on DHEA. ’trigger you then increase the cortisol and you might have some extra breakouts, however normally girls will know as a result of they’ll take 5 milligrams, which is a tiny dose they usually escape. So cease the DHEA.

Betty Rocker (30:41):

Proper. Uh, I believe it is a good alternative for us to shift just a little bit to the postmenopausal dialog. I wanna discuss the whole lot abruptly, in every single place, in fact. However, however I actually need, I’m actually and curious as a result of I’ll be in publish menopause quickly and I wanna know what to anticipate. And I’ve obtained lots of girls who pay attention who’re in publish menopause, they usually wanna know, properly, what ought to, is there one thing, how, what assessments ought to I get? After which what choices are there for me? What ought to we do and the way can we assist them?

Dr. Jill Carnahan (31:14):

Yeah. So there’s principally two or 3 ways this might occur. We talked about like, say you’re 35, 40, 45, and also you’re beginning up signs and your physician’s open and also you get some prescriptions. You may really undergo this very easily after which hit menopause and type of have been on hormones. Certain. However what you’re speaking about, I believe is say that girl out there may be 65 they usually have by no means been on hormones. By no means.

Betty Rocker (31:33):

Sure.

Dr. Jill Carnahan (31:33):

Proper.

Betty Rocker (31:34):

Proper.

Dr. Jill Carnahan (31:34):

They usually’re like, properly, what about me? Properly, very first thing is Dr. Dale Bredezen does a ton of analysis on Alzheimer’s. And he’s one Who’s that? Dr. Dale Bredezen. Okay.

Betty Rocker (31:42):

He

Dr. Jill Carnahan (31:42):

Wrote the e book Finish of Alzheimer’s. And he’s certainly one of our researchers and main specialists in dementia. And I discussed this as a result of in his protocols, there’s a kind of Alzheimer’s that’s associated to lack of estrogen within the feminine mind.

Betty Rocker (31:55):

Wow.

Dr. Jill Carnahan (31:56):

So he’s placing 85-year-old girls on hormone as a result of it’s so essential to our mind perform. And, and so this previous fable was that, oh, after 65, we don’t want hormones. So if we’re on hormones, we cease at 65. Or if we’re above 65, you’re too previous for hormones. That isn’t true. Our brains, until the tip of our life can use the hormones. Now, perhaps sooner or later you want lesser doses, however I might say to any girl who’s postmenopausal and perhaps having signs, perhaps not, I might nonetheless begin with testing after which discuss clinically about signs after which discuss security. Security’s the identical factor right here. However what occurs is, say you went, uh, into menopause at, otherwise you hit menopause 55 and also you’ve been with out hormones for 10 years, your receptors begin to and shrink up. So what occurs is if you first begin hormones, you probably have by no means been on them, there’s just a little little bit of adjustment as a result of it’s possible you’ll not both be capable of sense that hormone properly, or it’s possible you’ll in a short time get flooded with an excessive amount of. So it simply takes a practitioner who’s cautious with that, however they’re really with coronary heart, mind, and bone. There is no such thing as a age too previous that doesn’t profit from hormones so long as there’s a dialog and all of that

Betty Rocker (33:06):

Occurring, and it’s approached rigorously. That makes complete sense. And I’m so glad you stated that. Um, a few of the telehealth websites that assist girls with balancing their, their hormones publish menopause, they are saying that they’re, they’re not gonna prescribe in case you’ve, or they, they, there’s some wording about in case you’ve been 10 years with out having a interval and also you haven’t by no means been on HRT, like they, they wanna test in about that due to precisely what you’re speaking about. Like these receptor websites type of, are they atrophy, such as you stated? Yeah. However that there nonetheless could possibly be, that you just nonetheless may have that chance. So, so say, say somebody got here to you and he or she’s similar to perhaps a couple of years in to publish menopause. What would you take a look at her for? What would you be taking a look at? Would you have a look at, I imply, you most likely nonetheless wanna see like what her ranges of estrogen or like, you most likely wanna test her cortisol, I don’t know. What, what do you type of have a look at to, to assist her? And, and clearly it’s individually based mostly as properly, but when she’s serious about some kind of hormone alternative remedy, I assume what, what dialog and the way do you take a look at?

Dr. Jill Carnahan (34:04):

Yeah. So we’d nonetheless do most likely blood work or Dutch hormones, one or the opposite, or each. After which what we’d wanna do is there’s a threat of you probably have uterine fibroids which might be unchecked and really massive, otherwise you had extreme endometriosis, so any of the endometrial illnesses, this implies like the liner of your, your uterus was irregular or thick. Or you may have these growths which might be benign progress, however they’re stimulated by estrogen. These situations, um, could possibly be stimulated even by wholesome bioidentical hormones and fibroids are benign, however they’re a ache you probably have them. They’re massive or uncomfortable. They’re sometimes not malignant, which implies like they’re not most cancers. However these are caveats or issues that as, as a doctor, I’d be very involved or have a dialogue about. And in addition, if you’re perimenopause or in these earlier years, forties or fifties, and you’ve got had an enormous situation with fibroids or endometriosis, these are discussions we wanna have about how one can dose this and be watching that rigorously.

(35:00)
So sometimes a lady who’s by no means had any hormones, I might display screen them with a pelvic ultrasound to simply have a look at that pelvis and ensure the whole lot’s protected. As a result of if they’ve fibroids, these may develop with hormones. And you need to know that after which be capable of watch it. If any girl has breast tenderness with these, uh, hormones, that’s an indication. I’m at all times like, oh, that’s, you’re hitting your threshold. We’ll, most likely ought to decrease it. In order that’s like a warning factor. I’ll say, you don’t wanna have breast tenderness, or in case you do and it’s simply transient for per week and it goes away, that’s most likely okay. After which the third factor is in case you ever cease bleeding for over a yr, that’s technically the definition of menopause. You’ve gone into publish menopause, um, and also you begin to have bleeding that yr with no cycle that requires you to get an endometrial biopsy and a workup to ensure your lining just isn’t getting too thick. And these are simply these cautious issues {that a} good physician would do in case you’re on hormones, as a result of hormones may cause that lining to get thicker. And so you probably have a excessive threat of that, or some motive, you’d must have that dialogue about security and efficacy together with your physician. However I might at all times do a pelvic ultrasound and test their scientific historical past after which discuss with them rigorously. I might additionally most likely begin a 70-year-old girl on a a lot, a lot, a lot decrease dose than I might a 45-year-old girl.

Betty Rocker (36:10):

Certain. Thanks for sharing that. And that’s so useful to know as we go into this stuff, we wanna have our eyes open about threat elements. And also you talked about that you just, you do a Dutch take a look at as one of many choices for a post-menopausal girl. However since she isn’t having a cycle anymore, when does, when do you, when do you do try this? Yeah, anytime You are able to do it that

Dr. Jill Carnahan (36:29):

Anytime. Proper,

Betty Rocker (36:30):

Proper. Since you’re simply seeking to see the place her ranges are at in order that you would decide now. After which for somebody who’s post-menopausal, are you gonna be placing her or a person as an anyone, I assume, would they be getting on the same protocol to what somebody in perimenopause is getting on? Are you gonna be giving all of them the identical varieties of hormones? Would they want all of them? Or are you, are they extra prone to be simply getting on an estrogen or perhaps some testosterone? Or is there a motive to nonetheless add progesterone? I’m simply so .

Dr. Jill Carnahan (36:57):

Sure. So, um, the, the standard medical coaching is you probably have a uterus and you utilize unopposed, estrogen, which means all you get is estrogen, that’s a threat for that lining being thicker and really growing endometrial most cancers. So we as physicians who’re doing good work, would by no means give a lady who nonetheless has her uterus unopposed estrogen by itself. You’ll at all times give it with progesterone. Progesterone protects you from having that. So no matter age it’s, and if I consider order of operations so far as security, and even from 35 on what you do, progesterone virtually at all times comes first for a lot of girls, as a result of many ladies from 35 to 45 do rather well with simply progesterone. They don’t want any estrogen. There’s estrogen dominant, that’s what the ketchup, the Heinz ketchup factor is.

Speaker (37:39):

Yeah.

Dr. Jill Carnahan (37:40):

After which finally as they hit the ovaries begins to tank, then they, we add the estrogen. And so somebody older, I might begin with progesterone estrogen alone, earlier than I might add lots of testosterone DHEA, as a result of then you would, there’s, as you possibly can inform, the variables are virtually infinite in how with, yeah. So it’s a lot simpler to, to evaluate with some small quantities of estrogen, progesterone first, see how they do in two or three months, after which if wanted, add just a little testosterone. Um, and see, and I might say extra girls above the age of 65 are on a really small dose of estrogen, progesterone with out testosterone. However even they will profit from small doses if applicable.

Betty Rocker (38:17):

Fascinating. Wow. Properly, you’ve given us lots of actually nice info to consider, however I believe that one factor that we have now not talked about but, that’s at all times been part of our work collectively that I wanna be certain girls hear about is what hormones are doing in our physique and the way they’re really excreted. As a result of there’s a actually essential facet of our hormone steadiness that has to do with our intestine well being. Proper. And would you communicate on that just a little bit, as a result of I, I believe that is one thing that you just care quite a bit about and also you’ve guided me rather well on as properly.

Dr. Jill Carnahan (38:51):

Thanks, um, Bree, as a result of it’s, so what occurs is estrogen, progesterone, all these hormones in our physique, they’re handled by our liver, similar to a drug or a chemical. So we have now to detoxify these. And infrequently when girls get into hassle, even with threat of breast most cancers, endometrial most cancers, any type of hormone associated situation, it’s not that their hormones are the unhealthy guys, it’s that they’re not in a position to eliminate the surplus. They accumulate sure metabolites that may injury DNA, and that results in unhealthy issues. And apparently, in our world that we stay in, there are hundreds and a great deal of issues that mimic estrogen. They’re known as endocrine disruptors on our physique. So lots of occasions the, our tub and physique merchandise are make-up, um, issues that since we use in our home, um, even atrazine that’s used on corn within the Midwest, and these chemical compounds act like hormetic or hormone results on our physique, and it’s very poisonous.

(39:43)
So it’s virtually worse the setting than the hormones we take, however we have now to consider that. So if I’m actually going deep or somebody has lots of concern, I’ll even go so far as to do genetic testing on their liver’s capability to deal with hormones, as a result of there’s a couple of totally different genetic, we name them snips, which simply means issues that you just don’t course of usually. Um, like say a standard particular person is 100% processing, it’s possible you’ll course of it 60% or 30%. So generally I have a look at sure ways in which you course of hormones. And people folks, I’d do decrease doses, I’d monitor them extra ceaselessly. Um, and once more, that is likely to be the ten% of the inhabitants. So you probably have a household historical past of most cancers, particularly hormone associated, or you may have a, you would possibly wanna get right into a deeper dialogue together with your physician, however on the core, what you are able to do is that this, you possibly can just be sure you are utilizing clear merchandise in your hair, in your face, in your physique.

(40:31)
Transdermal drugs work for a motive as a result of we take in the whole lot by means of our pores and skin. And if we’re placing stuff on our pores and skin, standard perfumes or stuffed with phthalates, um, or any non-organic produce typically has, um, glyphosate residues or, or, uh, pesticide residues and all this stuff have a poisonous impact. So I wish to hold it easy. And if we simply begin with clear air, clear water, clear meals to the very best of our capability, that provides us a basis for protected hormone alternative as a result of we’re not getting a bunch of additional alerts to our physique from the meals that we eat or the water that we drink.

Betty Rocker (41:05):

Sure. And even, even with out hormone alternative remedy, if our intestine just isn’t working optimally, we aren’t gonna be capable of course of extra. So like we talked just a little bit about estrogen dominance just a little bit in the past, and I do know that one of many issues that may make estrogen dominance worse, at the same time as we’re dropping that progesterone, perhaps we’re within the early phases of perimenopause, is, uh, not with the ability to course of the surplus estrogen that we do have out of our physique. Proper. And we’ve, there’s this part of the intestine microbiome known as the estrobolome that helps to course of the estrogen. And if it’s not working, if it’s not in a position to perform properly, it, it’s gonna ship that again into our system as soiled estrogen. What does that imply precisely? And the way does that, how does that influence us?

Dr. Jill Carnahan (41:51):

So that is actually massive and I’m so glad you introduced it up, as a result of what occurs is, um, our liver’s at all times doing the detox work and it simply squirts out stuff into the bile that’s presupposed to be eliminating, and that’s in our stool. So in case you’re a lady who has persistent constipation, that alone places you at increased threat of reabsorbing toxins out of your setting or meals. And even in case you’re on hormones and you’ve got persistent constipation, you’re gonna have extra hassle eliminating the identical dose as a lady with out constipation. So the bowels and eliminating are so essential to this entire pathway and to changing hormones appropriately. So if we’re not, principally that, that enterohepatic circulation, which is a extremely fancy phrase for the…,

Betty Rocker (42:28):

Did you say entero? And say it once more.

Dr. Jill Carnahan (42:30):

Enterohepatic. So it’s like intestine hepatic.

Betty Rocker (42:34):

Received it. Intestine liver.

Dr. Jill Carnahan (42:34):

Kinda like one other manner for intestine liver circulation, that pathway on a regular basis is being reabsorbed. And so if we have now a bunch of poisons in our intestine and we’re not pooping out each day, um, we’re gonna reabsorb toxins and we’re gonna reabsorb hormones and we are able to get extreme ranges. Um, so it’s a actually massive deal to, it’s like fiber alone, getting good fiber out of your meals, which you’re professional at that together with your meal plans and all of the issues that you just do as a result of that’s,

Betty Rocker (42:58):

However I’m an advocate for it as properly. Yeah. In addition to strolling, strolling after a meal Sure. Or strolling extra generally, like mm-hmm. That helps peristalsis all this stuff that assist the intestine and assist you may have your common motion. Sure. Yeah.

Dr. Jill Carnahan (43:08):

And that’s a part of hormone alternative, as a result of in case you’re not transferring your bowels, you will get extra poisonous. And this stuff which might be useful and delightful may grow to be a poison to your system.

Betty Rocker (43:17):

Yep. Yep. Precisely. So I, I’m so glad that you just talked about that as a result of it’s, other than any kind of hormone alternative remedy, our physique has this elimination course of naturally for the hormones that we have already got in our system, our pure hormones. And so if we’re not eliminating properly already, and we go pile hormones on high of that, like bioidentical hormones or no matter type of hormone alternative remedy you’re utilizing, and also you’re not eliminating properly, you simply set it so properly, we’re poisoning ourselves moderately than serving to ourselves. You’re, you’re turning one thing that’s this potion right into a poison. Proper, precisely. Which precisely we don’t need. Proper. We would like wanna take. Yeah. So, um, we talked about fiber, we talked about strolling extra. I believe staying hydrated additionally. So important for supporting intestine perform, chewing extra mindfully, chewing extra, slowing down if you eat to assist your salivary glands and the amylase and all the issues that assist digestive digestion start in your mouth. What different like little scorching ideas do you may have for folks to assist them with higher intestine well being? I simply stated a couple of.

Dr. Jill Carnahan (44:19):

Adore it. So I believe a superb probiotic, I love to do spores. Um, however there’s so many good ones on the market. I simply spores have tended to work with even my robust, uh, you realize, troublesome to deal with purchasers with intestine points. These are usually rather well tolerated. Um, one factor actually fascinating is there’s lots of pure substances that may assist us on these pathways, and you’ll discuss to your physician about these, however some which might be actual frequent are sulforaphanes, which come from broccoli sprouts mm-hmm . And sprouted, um, seeds and issues. In order that’s a terrific place. You should purchase it as a cap, however you may also sprout your broccoli and have that in your salads. Um, Calcium D Glucarate is a kind of, it helps this section two of the liver, so processing that hormones and we are able to really see markers within the stool if we’re doing particular testing for somebody who isn’t processing properly.

(45:02)
And we are able to add that calcium deg glucarate as a complement to assist them eradicate on this liver intestine entry. After which a 3rd one is DIM, and that is additionally a extremely highly effective one. Um, the one caveat with DIM is it’s so good at decreasing estrogen, and if somebody was like 65 and already having osteoporosis and already actually low estrogens, that’s sturdy sufficient that I most likely wouldn’t use it in that inhabitants, however I might, if it’s a 45-year-old girl on hormone alternative, having a tiny little bit of breast tenderness, these are type of the ways in which you would use that sulforaphane, Calcium D Glucarate, and DIM. After which in fact methylated B nutritional vitamins, simply B nutritional vitamins are essential for this course of. Um, and issues like NAC, which is actually supportive for the liver as properly.

Betty Rocker (45:46):

So, fascinating as you’re saying all of these, I’m remembering all of the protocols we did if you had been serving to me heal from, uh, mould publicity, which was horrible. And it, that occurred proper at the start of my perimenopause journey and lots of these issues that I wanted, the liver help, all of that. It was simply in, it’s simply fascinating pondering again on it now, you realize, there’s that nice Steve Jobs quote that was that “you possibly can’t join the dots wanting ahead, solely wanting backwards.” And now as I’m pondering again on all the various things, oh yeah. The way you handled me, I’m understanding the connections that we made there and the ways in which you actually had been attempting to assist help all of these holistic processes and all of these issues I used prior to now that I don’t want particularly anymore mm-hmm .

(46:28)
And that, that basically will get me again to this factor that ladies want entry to particular, individualized healthcare that’s this, that has this breadth, that has this depth that, that cares about these totally different points of our well being and is educated in that sense. You understand, and and I, I’ve been so fortunate to have you ever in my life, and for individuals who, who don’t get to have you ever as a result of you may have a follow. You, you may have, you may have a tremendous e book. There’s a film about you . You will have, uh, an unbelievable web site with this depth of data so that folks can be taught extra and grow to be advocates for themselves with their very own medical doctors. You will have a complement retailer the place folks should purchase lots of some of these dietary supplements for themselves. And I simply, I really feel like you may have lots of wonderful sources. And is there something I neglected of that as a result of, properly, your social media, what else did I neglect to say? Your

Dr. Jill Carnahan (47:28):

YouTube podcast visitor, however yeah, that’s it.

Betty Rocker (47:30):

Your podcast, proper? Your unbelievable podcast, which I’ve been honored to be a visitor on myself.

(47:34)
Um, however the place I used to be going partly with that, other than saying, okay, women, all of us want these sources and right here’s a few of what you will get from Dr. Jill. Um, and Dr. Jill and I had been speaking earlier than this podcast began about, properly, the place else can girls go? Sure. And I used to be saying, I’ve been researching these totally different firms that try this follow telehealth, and I’m gonna learn a couple of and I’ll in fact have all these linked within the present notes. And, um, I bear in mind I ran them by you earlier, Dr. Jill. ’trigger I simply wanna guarantee that this was a superb, that I wasn’t going. You understand, I, I assumed they had been nice. But it surely’s good to listen to your vote of confidence in these as properly, as a result of that is I believe the way forward for that kind of medication. And, and for girls particularly? Sure.

(48:15)
So listed here are a pair that I discovered. One known as Midi and I really like midi. It’s like M-I-D-I and it’s, it’s a feminine based firm. It’s all these cool girls medical doctors and it’s telehealth firm. There’s telehealth choices, proper? After which in addition they will prescribe hormone alternative remedy or no matter you’re snug with and no matter you want. And I simply watched a pair movies from one of many co-founders and was simply so impressed. She jogged my memory of you. She was so cool and all the way down to earth and like she, it was all very private for her ’trigger she’s gone by means of the journey herself. So I really like Midi. One other one which I discovered, clearly you’ve most likely heard of Winona. I believe Winona’s been round for a short time they usually’re nice. Additionally they have the telehealth choices. Um, one other one I discovered that’s down in Tampa, however they do, uh, telehealth and, and do numerous cool prescribing is defy, like they’re known as Defy, which I like.

Dr. Jill Carnahan (49:04):

Love

Speaker (49:04):

It. Def. I like it.

Betty Rocker (49:06):

Yeah. Defy. After which there’s one known as Stella And Stella I assumed was actually cool. They’re additionally, in addition they have telehealth choices. They’ve the hormone alternative remedy choices. They’re, um, they’ve an internet site for US based mostly sufferers in addition to UK based mostly sufferers. Oh, good. So you possibly can, you need to use one or the opposite relying. I do know lots of you guys are within the UK that, that hearken to my podcast. Thanks a lot. Um, after which I additionally, I used to be eager about my, my folks in Australia. Um, there’s one thing known as Clinic 66, and if, in case you’re, in case you’re searching for choices for your self in your nation, I believe simply utilizing a few of these key phrases that Dr. Jill and I had been speaking about at the moment on this podcast, like, search for issues like telehealth, choices for hormone help in menopause. I really feel like I did that myself at totally different occasions and I’ve, and and I put it into totally different nations to see like, the place are they doing these things? And you then simply learn what’s on the web site and you then simply type of must comply with the threads and see the place, the place, the place it’s gonna be just right for you. And I’ve seen the US based mostly ones, a few of them have limitations by state Yeah. That they’re gonna deal with. And are you aware a lot about that or like, you realize, I do know you’re not gonna know what every particular person gonna do, however what are a few of the limitations that you just do know of in

Dr. Jill Carnahan (50:15):

State? Sure. Um, medical medical doctors are nonetheless licensed by state. So you actually, um, sometimes are, except somebody involves see me in Colorado, I’m, I’ve to be extra cautious about who I deal with outdoors of the state. In order that’s a complete deal. One of many issues that is likely to be tremendous useful is you probably have a compounding pharmacy in your space, that’s a terrific place to name as a result of they know what physicians in your space are prescribing hormones. And normally the compounding pharmacies additionally know who actually know, as a result of they’re gonna be, like, for me, they know I prescribe lots of hormones. I discuss to the pharmacies on a regular basis. And so a good way is that if you realize there’s a compounding pharmacy in your space, you name ’em and say, Hey, what medical doctors are you aware in my space which might be doing this? And that’s one other good solution to get in your space. Somebody who’s legit and your compounding pharmacy will sometimes know who that is likely to be.

Betty Rocker (50:56):

And with a view to discover a compounding pharmacy, would you simply Google compounding pharmacy in my space?

Dr. Jill Carnahan (51:00):

Yeah. Yeah. There’s P-C-C-A was the largest, um, group that, uh, licensed Ok, so PCCA, I don’t know precisely what it’s one thing “Coumpounding Pharmacies of America”. However, um, if it’s simply pcca.org, I assume, I don’t know the precise website it’s best to be capable of discover, uh, firm pharmacies. However yeah, you may also simply Google compounding pharmacy in my space.

Betty Rocker (51:21):

That’s nice. And I, I believe, I imply, and there are various greater than those that I simply, that quick checklist I gave you guys. I, I’ve, I’ve, I really like all, I really like all these choices which might be on the market for us. And I really feel prefer it’s, it’s, it’s gonna get higher. It’s, there’s gonna be increasingly more of them hopefully over time, however actually simply having this dialog, asking for what you want, advocating for your self. I, you and I had a dialog, um, a month or two in the past and we had been speaking about the way you stated at the moment, like some medical doctors you’re feeling like they gaslight their sufferers and it it’s as a result of they don’t know. Proper? They don’t have a clue. Proper. And I stated on a podcast the place we had been speaking about this, I used to be like, I really feel just like the medical doctors don’t imply to be jerks about these things. They only don’t know. And in the event that they knew, they might perhaps attempt to get extra info, proper? As a result of all of them

Dr. Jill Carnahan (52:07):

Have, you concentrate on like, even me, if I graduated from med faculty and I’m informed that that is harmful and that I by no means look and by no means be taught, which lots of docs cease studying after, proper? Then why wouldn’t I say, oh, nope, don’t do it. That’s what I heard 2001, which is previous information now. Proper? In order that’s lots of them simply don’t know the newest knowledge and the protection.

Betty Rocker (52:22):

If we had been to count on science to be this static factor, and we are able to solely take no matter’s been stated earlier than, I imply, we’d by no means have any girls particular,

(52:29)
Proper? Like we’d don’t have anything we, that we have now to permit science to be this evolving like, studying course of. That’s what science is. You understand, they’re, they’re observing knowledge they usually’re reporting on it, and over time they get higher and higher at their strategies, hopefully. And yeah, I imply, simply seeing them, simply seeing, not them, however seeing the extra particular research accomplished on girls particularly. I imply, it’s like a revelation. You’re like, properly why didn’t we try this earlier than? I do know , it’s about time , proper? Don’t y’all have a mother? Like, don’t you may have a sister? Don’t. Yeah. So it’s simply, it’s nice to see that and I’m glad we’re having these conversations. However Dr. Jill, I simply wanna thanks once more a lot for taking the time to speak about all of this at the moment. We coated a lot in a short while. And is there something that I didn’t say or didn’t ask you that you just’d wanna be certain to get throughout simply in case?

Dr. Jill Carnahan (53:17):

No, simply thanks for the great work you do on the earth and uh, thanks for having me on. It’s at all times a lot enjoyable. It’s like having espresso with a buddy and in case you’re on the market and also you’re struggling for hormones, you don’t must. And there are simply, I really like the sources you gave. There are such a lot of individuals who do perceive this. Um, and uh, I might simply proceed to look till you discover these solutions.

Betty Rocker (53:36):

I might agree. I might agree with that. Sure. And thanks a lot in your work. And I’ll have hyperlinks within the present notes in fact. And with this video so that you guys can comply with up with Dr. Jill and get all of her unbelievable sources. She has so many, you’ve accomplished a lot work for girls and a lot work in your sufferers generally, women and men. Um, thanks once more a lot for being right here and we look ahead to speaking to you once more. Thanks you, thanks a lot. And hey Rockstar, thanks a lot for listening at the moment. It’s been nice to spend time with you. I hope you realized one thing that’s useful and I’ll have all these hyperlinks to the issues that we talked about, in addition to a few books and sources Dr. Jill shared with me that we didn’t get an opportunity to speak about on the present. Be sure you try the present notes web page for this episode over on my weblog at thebettyrocker.com within the podcast part for all of these hyperlinks. And I hope that wherever this finds you, you take nice care of your self. Until subsequent time, I’m Betty Rocker and you’re so superior, flawsome and wonderful. Bye for now.